Therapeutic methods and delivery systems utilizing sex steroid precursors

ABSTRACT

Sex steroid precursors such as dehydroepiandrosterone and dehydroepiandrosterone sulphate, and compounds converted in vivo to either of the foregoing, are utilized for the treatment and/or prevention of vaginal atrophy, hypogonadism, diminished libido, osteoporosis, urinary incontinence, ovarian cancer, uterine cancer, skin atrophy, for contraception, and, in combination with an estrogen and/or progestin, for the treatment of menopause. The precursors may be formulated for percutaneous or transmucosal administration. Gels, solutions, lotions, creams, ointments and transdermal patches for the administration of these precursors are provided, as are certain pharmaceutical compositions and kits which can be used for the prevention and treatment of a wide variety of conditions related to decreased secretion of sex steroid precursors by the adrenals.

RELATED APPLICATION

This patent application is a division of application Ser. No.08/180,361, filed Jan. 18, 1994, which is in turn a continuation-in-partof U.S. patent application Ser. No. 08/005,619, filed Jan. 19, 1993, nowabandoned.

BACKGROUND OF THE INVENTION

This invention relates to a method for preventing and/or treatingvaginal atrophy, hypogonadism, diminished libido, osteoporosis, urinaryincontinence, ovarian cancer, uterine cancer, and menopause orcontraception in susceptible warm-blooded animals including humansinvolving administration of dehydroepiandrosterone (DHEA),dehydroepiandrosterone-sulfate (DHEA-S) or compounds converted in vivoto either and to pharmaceutical products, including kits andpharmaceutical compositions for delivery of active ingredient(s) usefulto the invention.

Primates are unique in having adrenals that secrete large amounts of theprecursor steroid dehydroepiandrosterone (DHEA) and especiallyDHEA-sulfate (DHEA-S), which are converted into androstenedione(Δ4dione) or androstene-diol (Δ⁵ -diol) and then into potent androgensand estrogens in peripheral tissues (Adams, Mol. Cell. Endocrinol.41:1-17, 1985; Labrie et al., in Important Advances in Oncology (de VitaS, Hellman S, Rosenberg S A, eds), J B Lippincott, Philadelphia Pa., pp193-200, 1985). DHEA-S, the major steroid present in blood of both menand women is converted into DHEA and Δ5-diol in peripheral tissues, thusmaintaining a close correlation between the concentration of these threesteroids in the blood (Adams, Mol. Cell. Endocrinol. 41:1-17, 1985).Depending upon the relative activities of 17β-hydroxysteroiddehydrogenase (17β-HSD), aromatase and 5α-reductase, DHEA or itsderivatives will be preferentially converted into androgens and/orestrogens.

The low serum values of DHEA and DHEA-S found at birth persist up to sixyears of age. Usually, during the 7th year of age, serum levels of thesetwo steroids increase and continue to rise until age 16 in both boys andgirls (Orentreich et al., J. Clin. Endocr. Metab. 59:551-555, 1984). Afurther increase is then seen in males, who typically reach maximallevels between 20 and 24 years of age. In women, there is usually nofurther increase after 16 years. DHEA and DHEA-S decrease with aging inboth men and women (Vermeulen and Verdoreck, J. Steroid Biochem. 7:1-10,1976; Vermeulen et al., J. Clin. Endocr. Metab. 54:187-191, 1982). Infact, at 70 years of age, serum DHEA-S levels are at approximately 20%.of their peak values while they decrease by up to 95% by the age of 85to 90 years (Migeon et al., J. Clin. Endocr. Metab. 17:1051-1062, 1957).The 70% to 95% reduction in the formation of DHEA-S by the adrenalsduring aging results in a dramatic reduction in the formation ofandrogens and estrogens in peripheral target tissues, thus resulting ina marked decrease in the biochemical and cellular functions induced bysex steroids.

In addition to the decrease in DHEA-S formation, in men, a progressivedecrease in the concentration of testosterone in the spermatic vein(Giusti et al., Exp. Gerontol. 10:241-245, 1975) as well as in plasma(Lewis et al., Acta Endocrinol. 82:444-448, 1976; Zumoff et al., J.Clin. Endocr.Metab. 54:534-538, 1982) has been observed after the age of60-70 years. Such data, however, have been the subject of controversy(Nieschlag et al., J. Clin. Endocr. Metab. 55:676-681, 1982). Inpostmenopausal women, serum testosterone levels are lower than duringreproductive life (Forest MG, Physiological changes in circulatingandrogens, in Androgens in Childhood (Forest MG, ed), Karger Basel, p.104-129, 1989).

The skin is an important site of sex steroid formation and its functionis known to be regulated by sex steroids. Sex steroids can act directlyin the skin or may stimulate growth hormone and prolactin secretion bythe anterior pituitary gland. Skin atrophy is in fact known to occur ingrowth hormone deficiency, probably through a secondary decrease ininsulin-like growth factor (IGF-1) secretion. Serum growth hormone (GH)and insulin-like growth factor (IGF-1) levels are known to be reduced inaging men and women.

Plasma DHEA-S concentration has been suggested as a predictor ofosteoporosis (Nordin et al., J. Clin. Endocr. Metab. 60:651-657, 1985;Deutsch et al., Int. J. Gynecol. Obstet. 25:217-220, 1987). Serum DHEAhas in fact been found to be significantly lower in osteoporoticcompared to normal subjects (Nordin et al., J. Clin. Endocr. Metab.60:651-657, 1985). Low tissue Δ4-dione is also likely to accompany lowDHEA-S levels. Since Δ4dione is the precursor of estrone which is a mainsource of estradiol in postmenopausal women (Marshall et al., Clin.Endocrinol. 9:407, 1978), such secondary low levels of estrogens arelikely to be involved in osteoporosis (Nordin et al., Lancet 2:277,1981).

As another mechanism, low serum DHEA-S levels resulting in low formationof androgens in peripheral tissues could also result in low boneformation, a characteristic of postmenopausal osteoporosis (Meunier etal., in Histological heterogeneity of apparently idiopathic osteoporosisand treatment (DeLuca H F, Frost H M, Jee W S S, Johnston Jr C C,Parfitt A M, eds), University Park Press, Baltimore, p. 293). In fact,Deutsch et al. (Int. J. Gynecol. Obstet. 25:217-222, 1987) have found asignificant correlation between serum DHEA-S and androstenedione levelsand osteoporosis in late postmenopausal women while no correlation wasfound between serum estrogens and bone density, thus suggesting a majorimportance of androgens in postmenopausal bone loss.

Studies in animals have shown that androgen deficiency leads toosteopenia while testosterone administration increases the overallquantity of bone (Silverberg and Silverberg, 1971; See Finkelstein etal., Ann. Int. Med. 106:354-361, 1987). Orchiectomy in rats can causeosteoporosis detectable within 2 months (Winks and Felts, Calcif.Tissue. Res. 32:77-82, 1980; Verhas et al., Calcif. Tissue Res.39:74-77, 1986).

As mentioned earlier, adrenal androgen levels have been found to bereduced in osteoporosis (Nordin et al., J. Clin. Endocr. Metab. 60:651,1985). Moreover, elevated androgens in postmenopausal women have beenshown to protect against accelerated bone loss (Deutsch et al., Int. J.Gynecol. Obstet. 25:217-222, 1987; Aloia et al., Arch. Int. Med.143:1700-1704, 1983). In agreement with such a role of androgens,urinary levels of androgen metabolites are lower in postmenopausalsymptomatic menopausis than in matched controls and a significantdecrease in conjugated dehydroepiandrosterone (DHEA) was found in theplasma of osteoporotic patients (Hollo and Feher, Acta Med. Hung.20:133, 1964; Urist and Vincent, J. Clin. Orthop. 18:199, 1961; Hollo etal., Acta Med. Hung. 27:155, 1970). It has been suggested thatpostmenopausal osteoporosis results from both hypoestrogenism andhypoandrogenism (Hollo et al., Lancet, 1357, 1976). Since aging (andosteoporosis) as accompanied by a decrease in an almost indefinitenumber of parameters and each tissue responds differently (including noresponse) depending upon the steroidogenic enzymes present, nocorrelation could be made between changes in DHEA levels and bone lossprior to the present applicants' findings described below regarding bonecells' processing of DHEA.

As a mechanism for the above-suggested role of both estrogens andandrogens in osteoporosis, the presence of estrogen (Komm et al.,Science 241:81-84, 1988; Eriksen et al., Science 241:84-86, 1988) aswell as androgen (Colvard et al., Proc. Natl. Acad. Sci. 86:854-857,1989) receptors in osteoblasts could explain increased bone resorptionobserved after estrogen and androgen depletion.

While, in women, there is a rapid bone loss starting at menopause, boneloss in males can be recognized at about 65 years of age (Riggs et al.,J. Clin. Invest. 67:328-335, 1987). A more significant bone loss is seenin men at about 80 years of age, with the accompanying occurrence ofhip, spine and wrist fractures. Several studies indicate thatosteoporosis is a clinical manifestation of androgen deficiency in men(Baran et al., Calcif. Tissue Res. 26:103-106, 1978; Odell andSwerdloff, West J. Med. 124:446-475, 1976; Smith and Walker, Calif.Tissue Res. 22 (Suppl.): 225-228, 1976).

Therapy of postmenopausal women with nandrolone increased cortical bonemineral content (Clin. Orthop. 225:273-277). Androgenic side-effects,however, were recorded in 50% of patients. Such data are of interestsince while most therapies are limited to an arrest of bone loss, anincrease in bone mass was found with the use of the anabolic steroidnandrolone. A similar stimulation of bone formation by androgens hasbeen suggested in a hypogonadal male (Baran et al., Calcif. Tissue Res.26:103, 1978).

The decline with age of serum levels of DHEA-S and DHEA has led to theintriguing possibility that low serum DHEA and DHEA-S levels could beassociated with breast cancer and cardiovascular diseases. In fact, aseries of studies have indicated that subnormal levels of DHEA areassociated with a high risk of breast cancer (Bulbrook et al., Lancet2:395-398, 1971; Rose et al., Eur. J. Cancer 13:43-47, 1977; Thijssen etal., J. Steroid Biochem. 6:729-734, 1975; Wang et al., Eur. J. Cancer10:477-482, 1974; Gomes et al., C.R. Acad. Sci. Paris 306:261-264, 1978;Brownsez et al., Eur. J. Cancer 8:131-137, 1972). Women with breastcancer were found to have low urinary levels of androsterone andetiocholanolone, two metabolites of DHEA (Bulbrook et al., Lancet2:1238-1240, 1962; Cameron et al., Br. Med. J. 4:768-771, 1970).Bulbrook et al. (Lancet 2:1235-1240, 1962) then reported that women withprimary operable breast cancer had urinary levels of11-deoxy-17-ketosteroids (derived mainly from DHEA-S and DHEA) lowerthan normal, thus suggesting that a low secretion rate of DHEA andDHEA-S could precede the development of breast cancer.

The main approaches for the treatment of already developed breast cancerare related to the inhibition of estrogen action and/or formation. Therole of estrogens in promoting the growth of estrogen-sensitive breastcancer has been recognized (Lippman, Semin. Oncol. 10 (Suppl. 4): 11-19,1983; Sledge and McGuire, Cancer Res. 38:61-75, 1984; Witliff, Cancer53:630-643, 1984; Poulin and Labrie, Cancer Res. 46:4933-4937,1986).

DHEA (450 mg/kg, b.w., 3 times a week) markedly delayed the appearanceof breast tumors in C3H mice which were genetically bred to developbreast cancer (Schwartz, Cancer Res. 39:1129-1132, 1979). Moreover, therisk of developing bladder cancer was found to be increased in menhaving lower serum DHEA levels (Gordon et al., Cancer Res. 51:1366-1369,1991).

Copending U.S. patent application Ser. No. 07/785,890 filed Nov. 4,1991, relates to a method of treatment of breast and endometrial cancerin susceptible warm-blooded animals which may include inhibition ofovarian hormonal secretion by surgical means (ovariectomy) or chemicalmeans (use of an LHRH agonist, e.g. D-Trp⁶, des-Gly-NH₂ ¹⁰ !LHRHethylamide, or antagonist) as part of a combination therapy.Antiestrogens, androgens, progestins, inhibitors of sex steroidformation (especially of 17β-hydroxysteroid dehydrogenase- oraromatase-catalyzed production of sex steroids), inhibitors of prolactinsecretion and of growth hormone secretion and ACTH secretion arediscussed. A counterpart thereof has been published under internationalpublication number WO 90/10462.

Copending U.S. patent applications 07/724,532 and 07/900,817 filed onJun. 28, 1991 and Jun. 24, 1992, respectively, relate to a method usinglow dose androgenic compounds for the prevention and treatment of breastcancer, endometrial cancer, osteoporosis and endometriosis. Acounterpart of the 1992 application has been published as WO 93/00070.

Recent in vitro studies describe the relative antiproliferativeactivities of an androgen on the growth of the estrogen-sensitive humanmammary carcinoma cell line ZR-75-1 (Poulin et al. "Androgens inhibitbasal and estrogen-induced cell proliferation in the ZR-75-1 humanbreast cancer cell line", Breast Cancer Res. Treatm. 12:213-225, 1989).As mentioned above, Poulin et al. (Breast Cancer Res. Treatm.12:213-225, 1989) have found that the growth of ZR-75-1 human breastcarcinoma cells is inhibited by androgens, the inhibitory effect ofandrogens being additive to that of an antiestrogen. The inhibitoryeffect of androgens on the growth of human breast carcinoma cellsZR-75-1 has also been observed in vivo in nude mice (Dauvois and Labrie,Cancer Res. 51:3131-3135, 1991).

DHEA has been suggested to have beneficial effects in obesity, diabetes,atherosclerosis, chemically induced breast, skin and colon (prevention)cancer, autoimmune diseases, fatigue, loss of muscle mass, connectivetissue diseases, aging and longevity (Orentreich et al., J. Clin.Endocrinol. Metab. 59:551-555, 1984; Regelson, Ann. N.Y. Acad. Sci.521:260-273, 1988; Gordon et al., Adv. Enzyme Regul. 26:355-383, 1987;Schwartz, Adv. Cancer Res. 51:391-423, 1988; Barrett-Connor et al., NewEngl. J. Med. 315:1519-1524, 1986).

In aged Sprague-Dawley rats, Schwartz (in Kent, Geriatrics 37:157-160,1982) has observed that body weight was reduced from 600 to 550 g byDHEA without affecting food intake. Schwartz (Cancer 39:1129-1132, 1979)observed that C3H mice given DHEA (450 mg/kg, 3 times a week) gainedsignificantly less weight and grew older than the control animals, hadless body fat and were more active. The reduction in body weight wasachieved without loss of appetite or food restriction. Furthermore, DHEAcould prevent weight gain in animals bred to become obese in adulthood(in Kent, Geriatrics 37:157-160, 1982).

DHEA in the diet has been shown to be a potent antihyperglycemic andantidiabetic agent in mice with inherited obesity-glucose intolerancesyndrome (Coleman et al., Diabetes 33:26-32, 1984).

DHEA reduced the incidence of atherosclerosis in cholesterol-fed rabbits(Gordon et al., J. Clin. Invest. 82:712-720, 1988; Arad et al.,Arteriosclerosis 9:159-166, 1989). Moreover, high serum concentrationsof DHEA-S have been reported to protect against death fromcardiovascular diseases in men (Barrett-Connor et al., N. Engl. J. Med.315:1519-1524, 1986). Circulating levels of DHEA and DHEA-S have thusbeen found to be inversely correlated with mortality from cardiovasculardisease (Barret-Connor et al., N. Engl. J. Med. 315:1519-1524, 1986) andto decrease in parallel with the diminished immune competence (Thomanand Weigle, Adv. Immunol. 46:221-222, 1989). A study in man has shown aninverse correlation between fetal serum DHEA-S and low densitylipoprotein (LDL) levels (Parker et al., Science 208:512,1980).

In normal men, a placebo-controlled trial investigated the effect ofdaily oral administration of 1.6 g of DHEA for 28 days. Serum DHEAlevels were increased 2.5- to 3.5-fold in the DHEA-treated group whiletotal cholesterol and serum LDL cholesterol decreased by 7.1 and 7.5%,respectively (Nestler et al., J. Clin. Endocrinol. Metab. 66:57-61,1988). A decrease in body fat was found in 4 of the 5 men treated withDHEA for an average 31% decrease in percent of body fat with no changein total weight, thus suggesting a corresponding increase in musclemass. Drucker et al. (J. Clin. Endocrinol. Metab. 35, 48, 1972), Busteret al. (Am. J. Obstet. Gynecol. 166, 1163, 1992) and Welle et al. (J.Clin. Endocrinol. Metab., 71, 1259, 1990) have also administered DHEAorally to the human.

Obesity was found to be improved in the A^(vy) mutant mouse (Yen et al.,Lipids 12:409-413, 1977) and in the Zucker rat (Cleary and Zisk, Fed.Proc. 42:536, 1983). DHEA-treated C3H mice had a younger appearance thancontrols (Schwartz, Cancer Res. 39:1129-1132, 1979).

Brain concentrations of DHEA are 6.5 times higher than correspondingconcentrations in plasma (Lacroix et al., J. Steroid Biochem.28:317-325, 1987). DHEA and DHEA-S improve memory in aging mice (Floodand Roberts, Brain Res. 448:178-181, 1988). Serum DHEA-S concentrationsin patients with Alzheimer disease have been found to be 48% lower onaverage than in age-matched controls (Sunderland et al., Lancet ii: 570,1989). As mentioned above, DHEA administered chronically in the diet hasbeen shown to increase longevity by delaying the development of somediseases in particular strains of animals.

U.S. Pat. No 4,496,556 describes the use of DHEA or its derivatives totreat skin dryness by topical administration. Only local action on thesebaceous glands was described and no systemic action was observed.

U.S. Pat. No 4,542,129 describes a topical composition for treating dryskin in a patient comprising the combination of DHEA and/or derivatives,a keratolytic agent and a non-toxic dermatologically acceptable vehicle.

Great Britain Patent No 1246639 describes preparation of esters ofdehydroepiandrosterone for use as agents in the treatment of post andpremenopause, tachycardia and headaches. One problem facing the use ofDHEA in humans is that high doses are required apparently because alarge proportion of the compound is degraded in the liver before itreaches the blood stream after oral administration.

It is known that the efficiency of delivery of some drugs can beimproved by the use of certain pharmacologically inactive derivativeswhich are, by in vivo enzymatic or spontaneous reactions, transformedinto the active drugs (see generally H. Bundgaard, Design andapplication of prodrugs. In A textbook of Drug Design and Development.Edited by P. Krogsgaard-Larsen and H. Bundgaard. Harwood AcademicPublishers GmfH, Chur, Switzerland, 1991, pp. 113-191). For example,Druzgala et al., J. Steroid Biochem. Molec. Biol. 38, 149-154, 1991,describes prodrugs of glucocorticoids. Bodor et al. in U.S. patentapplication Ser. No. 4,213,978 and in German Patent ApplicationPublication No DE 29 48 733 disclose the use of thiazolidine derivativesof progesterone as topical drugs. Percutaneous absorption of prodrugderivatives of estrogens and progestins are reported by Friend DR inCritical Reviews in Therapeutic Drug Carrier Systems, vol. 7 (2), pp.149-186, 1990. Information about percutaneous absorption of drugs canalso be found in Skin Permeability (H. Schaefer, A. Zesch and G.Stuttgen, eds), Springer-Verlag, Berlin, Heidelberg, New York, 1982, pp.896.

Currently, low dose estrogen therapy is the standard approach used inperimenopausal and menopausal women to relieve vasomotor symptoms,urogenital atrophy, osteoporosis and other symptoms and signs associatedwith menopause (for review, see Edman, C. D., Estrogen ReplacementTherapy. In: The menopause, Springer-Verlag, New York, (edited by H. J.Buchsbaum), pp. 77-84, 1983). Detailed information about the menopauseand its therapy can be found in other chapters of this book. Obviously,such approaches limited to estrogen replacement therapy, associated ornot with progestins, do not reproduce the equilibrium between estrogensand androgens that occurs naturally from the transformation of DHEA intoits active metabolites in various target tissues.

Some esters of DHEA at position 3 are already described in thelitterature (Riva et al., J. Org. Chem. 54:3161-4, 1989; Parish andChistrakorn, Synth. Commun. 15:393-9, 1985; Rom Patent No RO 66924B;Jarosz and Zamojski, Tetrahedron 38:1453-6, 1982; Heublin et al., Z.Chem. 22:178, 1982; German Patent Application No DE 2534911; Khaidem etal., Indian J. Chem. Sect. B, 27B: 850-1, 1988; Pettit et al., J. Org.Chem. 52:3573-8, 1987; Hanson and Reese, J. Chem. Soc. Perkin Trans.1:647-649, 1985); European Patent Application No 84-105741; Heublein etal., Acta Polym., 35:673-7, 1984; Seevers et al., J. Med. Chem.,25:1500-3, 1982; Yamashita and Kurosawa, Agric. Biol. Chem., 39:2243-4,1975; Japan Patent Application JP 50005372; Pohlmann et al., Mol. Cryst.Liquid Cryst. 13:243-54,1971.

Alkanesulfonates of DHEA are described as inhibitors ofglucose-6-phosphate dehydrogenase activity in J. Pharm. Sci. 73:1643-5,1984.

In Britain Patent Application No GB 1246639 and S. Africa PatentApplication No ZA 6806112 discloses DHEA esters for the treatmentrespectively of post and premenopause tachycardia and headaches andclimateric complaints.

Leszczynski et al., in Biochem. Biophys. Acta, 1014:90-7, 1989; idem:1083:18-28, 1991, have reported esterification of DHEA by blood plasmaand Katz et al., in MCF-7 cell line in J. Steroid Biochem, 26:687-92,1987.

Ethyl carbonate of DHEA is reported by Weisz and Agocs in Arch. Pharm.(Weinheim, Ger), 319:952-3, 1986. Some halogeno esters of DHEA aredescribed by Challis and Heap in J. Chromatogr. 50:228-238, 1970 and byPinelly and Nair in J. Chromatogr. 43:223-228,1969.

Although DHEA has been suggested as involved in various biologicalfunctions, as discussed above, its pharmaceutical use as a therapeuticor prophylactic agent has been relatively limited. Its role inpreventing, reducing or even reversing progress of certain diseases hasnot heretofore been fully understood. The present invention nowdiscloses a number of new pharmaceutical uses of DHEA and of DHEA-S (orcompounds convertable in vivo to either). The invention also providesimproved methods of administering these agents which can overcome thedisadvantages associated, for example, with oral administration.

SUMMARY OF THE INVENTION

It is an object of the present invention to provide simple and efficientmethods for systemic delivery of sex steroid precursors such asdehydroepiandiosterone, dehydroepiandrosterone sulfate and analogs whichare converted in vivo to either DHEA or DHEA-S.

It is another object of the invention to provide novel methods ofpreventing and/or treating treatments of menopause, vaginal atrophy,hypogonadism, diminished libido, osteoporosis, loss of skin thicknessand cellularity (skin atrophy), urinary incontinence, ovarian cancer anduterine cancer.

It is another object of the invention to provide kits and pharmaceuticalcompositions for use in accordance with the invention.

It is another object to provide novel contraceptive method.

It is another object of the invention to provide novel sex steroidprecursors and pharmaceutical compositions thereof.

In one aspect, the invention provides a method for treating menopausecomprising administering to a patient in need of such treatment aneffective amount of at least one sex steroid precursor selected from thegroup consisting of dehydroepiandrosterone, dehydroepiandrosteronesulphate, and compounds converted in vivo to either of the foregoing, incombination with an effective amount of an estrogen, a progestin orboth.

In another aspect, the invention provides a pharmaceutical compositionfor the treatment of menopause and other indications discussed hereincomprising at least one sex steroid precursor selected from the groupconsisting of dehydroepiandrosterone, dehydroepiandrosterone sulphate,and compounds converted in vivo to either of the foregoing, and furthercomprising an estrogen or a progestin or both. One preferred combinationis precursor and estrogen. Another is precursor and progestin. In somepreferred embodiments, precursor, progestin and estrogen are used incombination. Estrogen is disfavored for male patients.

In another aspect, the invention provides a kit for the treatment ofmenopause having a first container which includes at least one sexsteroid precursor selected from the group consisting ofdehydroepiandrosterone, dehydroepiandrosterone sulphate, and compoundsconverted in vivo to either of the foregoing, and at least oneadditional container having either a progestin, an estrogen, or both.One preferred kit includes three containers having a precursor, anestrogen and a progestin, respectively, in separate containers.

However, 2 or more of the active ingredients may, if desired, be in asingle container. A pharmaceutical carrier or diluent may also beprovided in one or more of the containers and may include preservativesand many other additives known in the art.

In another aspect, the invention provides a method of treating vaginalatrophy, hypogonadism, diminished libido, reduced skin thickness andcellularity comprising administering to a patient in need of suchtreatment an effective amount of a sex steroid precursor selected fromthe group consisting of dehydroepiandrosterone, dehydroepiandrosteronesulphate, and compounds converted in vivo to either of the foregoing.

In another aspect, the invention provides a method for the prevention ortreatment of osteoporosis comprising administering to a patient in needof such prevention or treatment a therapeutically effective amount, withor without a pharmaceutical diluent or carrier, of a sex steroidprecursor selected from the group consisting of DHEA, DHEA-S andcompounds that are converted in vivo to either.

In another aspect, the invention provides a method for the prevention ortreatment of urinary incontinence comprising administering to a patientin need of such prevention or treatment, with or without additionalpharmaceutical diluent or carrier, a therapeutically effective amount ofa sex steroid precursor selected from the group consisting of DHEA,DHEA-S and compounds converted in vivo to either.

In another aspect, the invention provides a method of contraceptioncomprising administering to a female in need of contraception, with orwithout additional pharmaceutical diluent or carrier, an effectiveamount of a sex steroid precursor selected from the group consisting ofDHEA, DHEA-S and compounds converted in vivo to either. In preferredembodiments, an estrogen and/or progestin are further administered aspart of a combination method of contraception together with theprecursor.

In another aspect, the invention provides the pharmaceutical compositionof a sex steroid precursor selected from the group consisting of DHEA,DHEA-S and compounds converted in vivo to either, and a supplementalagent selected from the group consisting of an estrogen and a progestin.In certain embodiments, estrogen and progestin are both included.Preferably, a pharmaceutical diluent or carrier is also added in someembodiments.

It is also possible to make kits in accordance with the invention whichprovide at least two separate containers, one of which includes the sexsteroid precursor, and another of which includes either an estrogen or aprogestin or both. In certain embodiments, three separate containers maybe provided wherein one container has at least the sex steroid precursortherein, another container has at least the estrogen therein, andanother container has at least the progestin therein. All indicationsdiscussed herein as responding to the sex steroid precursors (DHEA,DHEA-S and compounds converted in vivo to either) may, in certainembodiments, further respond to administering estrogen and/or progestinin combination with the precursor (with the exception of treatment inmen where an estrogen would be disfavored). Thus, the kits andpharmaceutical compositions should provide the combination of theforegoing agents appropriate to the particular indication for which theywill be used, and the combination therapy chosen.

In another embodiment, the invention provides a method for prevention ofovarian cancer comprising administering to a female patient in need ofsuch prevention, with or without additional pharmaceutical diluent orcarrier, a therapeutically effective amount of a sex steroid precursorselected from the group consisting of DHEA, DHEA-S and a compoundconverted in vivo to either.

In another embodiment, the invention provides a method for prevention ofuterine cancer comprising administering to a female patient in need ofsuch prevention, with or without additional pharmaceutical diluent orcarrier, a therapeutically effective amount of a sex steroid precursorselected from the group consisting of DHEA, DHEA-S and a compoundconverted in vivo to either.

In another aspect, the invention provides a therapeutic method oftreating reduced or imbalanced concentrations of sex steroids comprisingapplying an effective amount of a pharmaceutical composition forpercutaneous or transmucosal delivery to an outer surface of skin ormucosa of a patient in need of such treatment, said pharmaceuticalcomposition comprising a carrier having dissolved therein at least onesex steroid precursor selected from the group consisting ofdehydroepiandrosterone, dehydroepiandrosterone sulphate, and compoundsconverted in vivo to either of the foregoing, said precursor beingpresent at a concentration of at least 7% by weight relative to thetotal pharmaceutical composition, and said carrier being compatible withskin or mucosa and allowing penetration of said precursor through saidskin or mucosa, said carrier having sufficient viscosity to maintainsaid precursor on a localized area of skin or mucosa, without running orevaporating, for a time period sufficient to permit substantialpenetration of said precursor through said localized area of said skinor mucosa. The foregoing method is useful in treating and/or preventingthe conditions discussed above, menopausal symptoms and other conditionswhich respond to replenishment of diminished DHEA levels, including butnot limited to obesity, cardiovascular disease, atherosclerosis, breastcancer, endometrial cancer, loss of muscle mass, diabetes, fatigue,connective tissue diseases and memory loss.

In another aspect, the invention provides a pharmaceutical compositionfor percutaneous or transmucosal delivery of said pharmaceuticalcomposition comprising a carrier having dissolved therein at least onesex steroid precursor selected from the group consisting ofdehydroepiandrosterone, dehydroepiandrosterone sulphate, and compoundsconverted in vivo to either of the foregoing, said precursor beingpresent at a concentration of at least 7% by weight relative to thetotal pharmaceutical composition, and said carrier being compatible withskin or mucosa and allowing penetration of said precursor through saidskin or mucosa, said carrier having sufficient viscosity to maintainsaid precursor on a localized area of skin or mucosa, without running orevaporating, for a time period sufficient to permit substantialpenetration of said precursor through said localized area of said skinor mucosa.

In another aspect, the invention provides novel compounds (andpharmaceutical compositions containing them) of the formulas set forthbelow with substituent definitions set forth below: ##STR1## wherein Xis selected from the group consisting of H, ##STR2## RCO₂ CHR^(a) - andR^(b) SO₂ --

R being selected from the group consisting of hydrogen, straight- orbranched-alkyl, straight- or branched-alkenyl, straight- orbranched-alkynyl, aryl, furyl, straight- or branched-alkoxy, straight-or branched-alkenyloxy, straight- or branched-alkynyloxy, aryloxy,furyloxy and halogeno analogs of the foregoing

R^(a) being hydrogen or (C₁ -C₆) alkyl; and

R^(b) being selected from the group consisting of hydroxyl (or saltsthereof), methyl, phenyl and p-toluyl;

wherein Y is a divalent ;substituted or unsubstituted moiety of theformula: ##STR3## (Z being an oxygen or sulfur atom), and wherein Y andthe carbon atom to which it is bonded together form a closed saturated5-membered ring. ##STR4## wherein R^(c) is selected from the groupconsisting of C₃ -C₂₀ straight- or branched-alkyl, C₃ -C₂₀ straight- orbranched-alkenyl, C₃ -C₂₀ straight- or branched-alkynyl, aryl andhalo-substituted analogs of the foregoing. ##STR5## R^(d) being selectedfrom the group consisting of hydrogen, straight- or branched-alkyl,straight- or branched-alkenyl, straight- or branched-alkynyl, aryl,furyl, straight- or branched-alkoxy, straight- or branched-alkenyloxy,straight- or branched-alkynyloxy, aryloxy, furyloxy and halogeno analogsof the foregoing.

wherein R_(a) is hydrogen or (C₁ -C₆) alkyl. ##STR6## wherein R³ ishydroxy or sulfate.

wherein R^(e) is selected from the group consisting of hydrogen, benzyl,aryl, straight- or branched-alkyl, straight- or branched-alkenyl andstraight- or branched-alkynyl.

wherein Z is oxygen or sulfur.

In one embodiment, a method is provided to compensate for the markeddecrease in the secretion of the sex steroid precursors DHEA and DHEA-Sby the adrenals during aging comprising administering DHEA, DHEA-S oranalogs converted in vivo thereto in amounts which compensate for theconsequences of decreased DHEA and DHEA-S secretion by the agingadrenals without exerting unwanted side effects.

It is believed that the methods of the invention are suitable for bothprophylactic and therapeutic use. The serum concentrations, kits, andcompositions discussed herein are equally useful toward eitherobjective.

In another aspect, the invention provides a transdermal devicecomprising;

(a) a surface adapted for contact with human skin;

(b) a means of maintaining said surface on a localized area of skin towhich said device is applied;

(c) a storage member in fluid communication with said surface, saidmember containing a pharmaceutical composition comprising a carrier andan active ingredient selected from the group consisting ofdehydroepiandrosterone, dehydroepiandrosterone sulphate and analogueswhich are converted in vivo to either; and

(d) a means for conducting said pharmaceutical composition from saidstorage member through said surface and into contact with said localizedarea of skin.

For all indications for which DHEA is recommended herein in accordancewith the present invention, it is to be understood that any sex steroidprecursor selected from the group consisting of DHEA, DHEA-S andcompounds converted in vivo to either (e.g. prodrug forms of DHEA orDHEA-S) may be used. All will result in increased serum levels of DHEA.Because DHEA-S is a natural precursor of DHEA, DHEA-S (as well asprodrugs to either of DHEA or DHEA-S) may be used in place of DHEA forthe various indications discussed herein for using DHEA. The result ofadministering these prodrugs or of administering DHEA-S is desirablyincreased levels of DHEA.

DESCRIPTION OF THE DRAWINGS

FIGS. 1-3 show the increase in bone density of rats after nine months oftreatment with DHEA (EM-760). FIG. 1 shows total bone mass density ofboth intact and ovariectomized rats treated for 9 months with DHEAversus an untreated control group of rats. FIG. 2 shows the samecomparison measuring lumber spine mass density, and FIG. 3 shows thesame comparison measuring femoral bone mass density. In each case,except of course for the intact control group, measurements were takennine months after ovariectomy and/or percutaneous DHEA administration.These figures illustrate the value of the present invention in thetreatment or prevention of osteoporosis.

FIGS. 4 and 5 illustrate the effectiveness of DHEA as a contraceptive,or for therapy or prevention of ovarian or uterine cancer. FIG. 4illustrates the reduction in rat ovarian weight achieved after sixmonths treatment with twice daily percutaneous administration of DHEA ata dose of 30 mg in 0.5 ml 50% ethanol-50% propyleneglycol on the dorsalskin area covering about two square centimeters thereof. FIG. 5illustrates histology of the ovaries of intact control rats (FIG. 5A)and intact rats treated with DHEA at a dose of 30 mg twice daily in asolution of 50% ethanol--50% propylene glycol applied on an area of 2cm² of dorsal skin (FIG. 5B). FIG. 5B shows a marked decrease in thenumber of tertiary and secondary follicles (F) and absence of corporalutea (CL); interstitial cells (IC). Magnification×250. Note the atrophyof the interstitial gland in the treated rat (FIG. 5C) in comparisonwith the intact (FIG. 5D) at magnification×500.

FIG. 6 illustrates the effect on vaginal atrophy of one, three or sixmonths of treatment with DHEA administered at a dose of 30 mg twicedaily in a solution of 50% ethanol--50% propylene glycol on an area of 2cm² of dorsal skin in the ovariectomized rat. Atrophic vaginalepithelium is shown after 1 (FIG. 6A), 3 (FIG. 6B), and 6 monthsfollowing castration (FIG. 6C). Reversal of vaginal atrophy in ratstreated with DHEA as shown in FIGS. 6D, 6E and 6F illustrating thevaginal epithelium after DHEA treatment for 1, 3, and 6 months,respectively. Magnification×200. Thus, histopathologic examinationshowed proliferation and murification of the vaginal epithelium andreversal of vaginal atrophy in the rats treated with DHEA.

FIG. 7 shows histology of the skin of male rats after 3 and 6 months oftreatment with DHEA given by topical application in an area of 2×2 cm ondorsal skin. Slight to moderate hypertrophy and hyperplasia of sebaceousglands in dorsal (b) and (c); as well as in ventral (e) and (f) skin ofintact treated rats for 3 months (b) and (e) and 6 months (c) and (f)compare with intact controls (a) and (d). Distention of ducts (D).

FIG. 8 shows histology of the skin of male rats after 3 and 6 months oftreatment with DHEA given by topical application in an area of 2×2 cm ondorsal skin. Slight to moderate hyperplasia of sebaceous glands indorsal (b) and (c); as well as in ventral (e) and (f) skin of castratedrats treated for 3 months (b) and (e) and 6 months (c) and (f). Comparewith castrated controls (a) and (d). Note the distention of ducts (D)and increase in the number of the acini (A) per hair follicle.Magnification×100.

FIG. 9. Effect of treatment with DHEA on dorsal skin dermis (area oftopical application of DHEA) in male castrated rats after 3 (c) and 6months (d) and (f). Castrated untreated rats were used as controls (a),(b) and (e). Increase in thickness and cellularity of dermis in treatedrats (c), (d) and (f). a, b, c, d: magnification×100; e,f:magnification×500.

FIGS. 7-9 above illustrate that topical application of DHEA on thedorsal skin leads to an increased thickness and cellularity of thedermis, an effect which should prevent or treat skin atrophy (acondition marked inter alia by loss of collagen connective tissue). Theeffects of DHEA are also visible on the size of the sebaceous glandswhich are believed to be stimulated by the androgenic compounds producedfrom DHEA as a precursor.

As can be seen in FIGS. 7 and 8, topical application of DHEA (30 mg in50% ethanol/50% propylene glycol) for 3 or 6 months on an area of 2×2 cmon dorsal skin leads to a slight to moderate hypertrophy and hyperplasiaof the sebaceous glands in both the dorsal and ventral skin areas, thusindicating a generalized effect of this treatment on the skin. Thiseffect is seen in both intact and castrated animals where the markedatrophy following castration is completely prevented by DHEA treatment.Such a decrease in the size of the sebaceous glands after castration canbe compared to the atrophy occurring during aging.

As illustrated in FIG. 9, the effect of DHEA is accompanied by a markedincrease in the thickness and cellularity of the dermis in both intactand castrated animals. Since collagen is an important component of theskin dermis, the present data indicate that the correction of skinatrophy could be achieved, at least in part, by increased formation ofcollagenous tissue. Regarding the effectiveness of DHEA as acontraceptive, topical administration of DHEA (30 mg) in 50%ethanol--50% propylene glycol twice daily on an area of 2 cm² on thedorsal skin of intact rats led to histopathological changes thatdemonstrate inhibition of ovulation. The most important changes observedwere an atrophy of the ovaries (FIG. 4) and histopathological changes(FIG. 5) indicating an absence of ovulatory cycles. There was a markeddecrease in the number of secondary and tertiary follicles and anabsence of corpora lutea, thus showing the absence of ovulation. Thesehistopathological signs of absence of ovulation in the ovaries were alsoaccompanied by an arrest of the cyclic histopathological changesnormally seen in the endometrium during the estrous cycle in the rat.These histopathological changes show that treatment with DHEA exertscontraceptive action.

The invention is further explained in the following non-limitingdescription of preferred embodiments.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

To select patients who may benefit from the treatments described herein,the serum levels of DHEA and its metabolites can be measured asdescribed by Belanger et al., in Steroid Formation, Degradation andAction in Peripheral, Normal and Neoplastic Tissues (H Bradlow, LCastagnetta, S d'Aquino, L Gogliotti, eds) Ann. N.Y. Acad. Sci. 586:93-100, 1990; Haning et al., J. Clin. Endocrinol. Metab. 72:1088, 1991.See also Labrie et al., Endocrinology 123, 1412-1417, 1988. Serum IGF-1levels can be measured as described (Furlanetto et al., J. Clin. Invest.60:648, 1977). In accordance with the invention, once the DHEAdeficiency is determined, DHEA or its analogues is preferablyadministered at a dosage sufficient to cause and maintain serum DHEAconcentration between 4 and 10 micrograms per liter, especially between4 and 7 micrograms per liter. Higher concentrations are desirable incertain indications as discussed below.

In some preferred embodiments, serum concentration is between 5 and 7 orbetween 6 and 7 micrograms per liter. However, for purposes ofcontraception or for prevention of ovarian or uterine cancer,concentration up to 13 micrograms per liter (e.g. between 7 and 13) arepreferred. Preferred dosages discussed herein may be increased asappropriate to achieve these higher serum concentrations, e.g. by afactor of about 30% with variations for individual patient response asmonitored by the attending clinician. When DHEA is administered by thepreferred percutaneous or transmucosal technique, it has been found thatDHEA is very efficiently absorbed into the blood to raise serum levels.For example, when a Glaxal cream, containing Glaxal base as a carrier(available from Glaxal Canada Limited) and 10% DHEA by weight of thetotal composition, is applied twice daily to a 100 square centimetersurface of the abdominal area in an amount providing 100 milligrams ofactive ingredient (e.g. DHEA), a typical patient is likely to respondwith an increase of serum DHEA concentration of about 0.7 micrograms perliter per 50 kg of body weight. The delivered dosage may be raised orlowered in known manners by altering the location to which the lotion orointment is applied, by altering the size of the surface area to whichit is supplied, by altering the concentration of the active ingredient,or by altering the carrier. For example, increasing the surface areawill normally increase the dosage of active ingredient delivered if theconcentration of active ingredient remains constant. In the same manner,dosage delivered increases with increased concentration of activeingredient in the delivery base, and decreases with decreasedconcentration. Dosage delivered into the bloodstream also varies in aknown manner with respect to the body region at which the transdermalpenetration system is applied to the skin. Changing the carrier can alsoalter the delivered dosage in known ways. Preferably, serum DHEAconcentration is measured before treatment begins, and a dosage isselected to quickly raise serum DHEA concentration to the preferredtarget range between 4 and 10 micrograms per liter or 7 to 13 microgramsper liter for the higher dosage indications discussed above.Subsequently, the patient is monitored both symptomatologically and byDHEA concentration to verify that the desired serum concentration targetand symptomatic relief have been obtained. DHEA is then maintained at aconstant concentration in the circulation. For a typical post-menopausalpatient, for example, this dosage is the equivalent of application of400 mg of the active precursor, as part of a 10 percent composition inGlaxal, to a 400 square centimeter area of the abdomen 2 times daily per50 kg of body weight. If oral administration is chosen, 800 mg should beadministered twice daily per 50 kg of body weight.

In accordance with the invention, DHEA, DHEA-S and/or compoundsconverted to either in vivo are utilized for the treatment and/orprevention of menopausal symptoms, vaginal atrophy, atrophy of the skin,hypogonadism, diminished libido, osteoporosis, urinary incontinence,ovarian cancer or uterine cancer. Additionally, other conditions relatedto decreased secretion of DHEA by the adrenals during aging and whichrespond to DHEA therapy can be treated more efficiently withtransdermally delivered DHEA, DHEA-S (or analogues) in accordance withthe invention. Conditions expected to respond to the treatments hereinmay be diagnosed in conventional ways. For example, the appearance ofbreast cancer is usually detected by self breast examination, clinicalbreast examination by the physician and/or mammography. Endometrialcancer, on the other hand, is usually diagnosed by the PAP smear and/orendometrial biopsy. Both cancers can be diagnosed and evaluated bystandard physical methods well known to those skilled in the art, e.g.bone scan, chest X-Ray, skeletal survey, ultrasonography of the liverand liver scan (if needed), CAT scan, MRI and physical examination. Thefirst manifestations of menopause are usually hot flashes. Furthercharacterization of menopause can be determined in accordance with knowntechniques. See for Example, The Menopause (Herbert J, Buchsbaurm, ed),Springer Verlag, New York (1983), pp. 222. Vaginal atrophy is oftenindicated by dyspareunia and vaginal infections. Vaginal atrophy,hypogonadism and diminished libido are all characterized in well-knownways. For the above-indicated diseases, see, for example, Korenman,Stanley G, "Sexual Dysfunctions" in Williams Textbook of Endocrinology(Jean D. Wilson and Daniel W. Foster, Eds.), W B Saunders Co,Philadelphia, pp. 1033-1048,1992.

Bone density, on the other hand, can be measured by standard methodswell known to those skilled in the art, e.g. QDR (Quantitative DigitalRadiography), dual photon absorptiometry and computerized tomography.Plasma and urinary calcium and phosphate levels, plasma alkalinephosphatase, calcitonin and parathormone concentrations, as well asurinary hydroxyproline and calcium/creatinine ratios are usefulparameters of bone formation and resorption.

Loss of collagen or connective tissues in the skin often accompaniesaging, especially in persons over 50 years of age. It may be evidencedby wrinkling of the skin and/or low elasticity.

Osteoporosis or otherwise insufficient bone mass, and other diseasestreatable by activating the androgen receptor may be treated inaccordance with the present invention or prophylactically prevented inaccordance herewith. The present invention can aid in the prevention ofbreast, ovarian or endometrial cancer.

The normal range of body weight is well known to those skilled in theart, while cholesterol and lipoproteins are routinely measured bystandard techniques (Nestler et al. J. Clin. Endocrinol. Metab.66:57-61, 1988 for references).

Skin status can be assessed by visual inspection, palpation and, withmore precision, by punch biopsy and standard histological examination.

The traditional main mechanism for female contraception in the prior artrelated to administering an estrogen , which at increased circulatinglevels, reduced LHRH secretion from the hypothalamus which, in turn,decreased LH secretion from the pituitary. The resultant reduction in LHsecretion decreased ovarian function, and in particular ovulation.Addition of a progestin controlled the growth of the endometrium andtransformed the vaginal and cervical secretions into an unfavorableenvironment for sperm capacitation and fertility.

In the present invention, DHEA is used instead of estrogen (althoughestrogen may also be added in certain embodiments discussed below). Inaccordance with the invention, DHEA provides estrogen for contraceptionwhile simultaneously and desirably providing increased levels ofandrogens which will contribute to contraception since androgens inhibitLHRH and LH secretion. These androgens can, especially in women atperimenopause (as well as in postmenopausal women when contraception isno longer required), provide much needed stimulation of bone formationand resistance to bone loss. The estrogens produced from theadministered DHEA also contribute to reducing bone loss. As with otheruses discussed herein, use of DHEA instead of a sex steroid (hereestrogen) avoids externally administering relatively high doses ofestrogens and this avoids giving such estrogens extensive access to alltissues, many of which do not require estrogens. By substituting DHEA,estrogens are instead produced by natural processes in the same tissueswhere estrogens and androgens are needed and that normally convert DHEAto estrogens and androgens. The relative proportions of estrogen andandrogen also remain substantially at natural levels in each specifictissue.

As with other uses of DHEA discussed herein, DHEA-S or prodrugs of DHEAor DHEA-S may be substituted instead or in addition to DHEA. Becauseovarian function is diminished by the contraceptive technique describedherein, ovarian production of estrogen and progesterone is decreased.Thus administering a progestin (e.g. medroxyprogesterone acetate,megestrol acetate, norethynodrel, L-norgestrel) to prevent endometrialhypertrophy as part of the contraceptive method is preferred. Androgenicprogestins are preferred. The progestin may be administered in apharmaceutical composition that includes the DHEA or separately. Incertain embodiments, the progestin may be administered intermittentlyevery month for 12-14 days, or 12-14 days every few months (e.g. every2-4 months) or continuously. Progestin dosage may be in the rangeutilized in the prior art but is preferably lower for reasons explainedbelow.

Estrogen may also be added to the contraceptive therapy because ofdecreased estrogen production in the ovaries. However, DHEA itself isconverted to estrogen in many tissues and externally added estrogen canbe minimized during practice of the present invention. Preferred dosageof added estrogen, when used in the contraceptive method is an amounteffective to achieve between 100 and 200 nanograms estradiol per literor equivalent. Preferably the ratio of added estradiol to DHEA (w/w)will range from 1,000 to 25,000 preferably 2,000 to 15,000 andespecially 3,000 to 12,000. As with added progestin, added estrogen maybe administered as part of a pharmaceutical composition that includesthe DHEA (or, where used, the DHEA-S or prodrug) or separately. In someembodiments, DHEA, progestin and estrogen are all administered, togetheror separately, as part of a combination therapy. A combination therapyresults whenever a regimen of treatment elevates blood levels of eachactive agent simultaneously. This simply requires that the active agentsbe administered sufficiently close in time that elevated blood levels ofthese agents were concurrent.

The use of combination contraceptives containing estrogens andprogestins has not been shown to reduce the risk of breast cancer(Romiev et al., 1990, Cancer 66:2253-63). These data are consistent witha known mitogenic effect of both estrogen and progesterone on breastcell epithelial proliferation, thus explaining a peak of cellproliferation at mid-luteal phase (Masters et al., J. Natl. Cancer Inst.1977, 58:1263-65; Anderson et al., 1982, Br. J. Cancer 46:376-82). Infact, total breast cell proliferation rate in premenopausal women usingcontraceptives is not different from that of untreated cycling women(Potter et al., 1988, Br. J. Cancer 58:163-170; Going et al., 1988, Am.J. Pathol. 130:193-204).

Applicant has recently discovered that DHEA is transformedpreferentially into androgens relative to estrogens. Thus, in accordancewith the invention, this prohormone is used as a contraceptive insteadof the current pill in order to desirably reduce breast cellproliferation. Androgens do in fact exert inhibitory effects on breastcell proliferation by two mechanisms, namely a direct inhibitory effectin breast cells, and an inhibitory effect on gonadotropin secretion atthe hypothalamo-pituitary level, thus resulting in decreased ovarianactivity (e.g. less estrogen secretion and thus less estrogen-inducedbreast cell growth).

In addition to its beneficial effect on breast cells, the DHEA-induceddecrease in gonadotropin secretion reduces ovarian activity (FIGS. 4 and5) and should thus help prevent ovarian cancer as well as uterinecancer. The increased gonadotropin secretion which precedes menopausewill thus be ameliorated by DHEA administration. In accordance with theinvention, DHEA may therefore be used prophylactically againstdevelopment of ovarian or uterine cancer in patients at high risk ofthese cancers even when contraception is not a primary objective. Priorart oral contraceptives add important amounts of the sex steroidsestrogens and progestins. The present approach, however, is based on thetissue-specific formation and action of predominant androgenssynthesized from DHEA. In fact, when peripheral tissues are exposed tothe precursor steroid DHEA, these tissues make androgens predominantlyas well as some estrogens at the site of action, the balance between thetwo categories of sex steroids being more physiological. DHEA will alsoblock gonadotropin secretion and thus protect the ovary fromhyperstimulation by high levels of gonadotropins preceding andaccompanying menopause. The large proportion of the inhibition ofgonadotropin secretion will be exerted by the DHEA-derived naturalandrogens, thus reducing to a minimum the needs for estrogens andprogestin. This is important because many progestins includingnorethindrone and norethynodrel possess strong estrogenic activity(Poulin et al., Breast Cancer Res. Treat. 13:265-276, 1989).

Applicant has now discovered that the precursor steroid DHEA isconverted to androgens (and estrogens) in osteoblasts (bone-formingcells). This discovery shows that, in accordance with the invention,DHEA may now be used instead of androgen and estrogen in the treatmentor prevention of osteoporosis. Androgens produced in the bone (byconversion of the administered DHEA) stimulate bone formation and reducebone loss, while estrogens produced from the administered DHEA alsocontribute to reducing bone loss. Significant side effects oftraditional androgen therapy are thus avoided. For example, externallyadministered androgens of the prior art have access to many tissues thatneither produce nor require androgens, thus causing side effects anddisturbing the physiological balance of sex steroids in those tissues.By substituting DHEA (or prodrugs or DHEA-S if desired) in accordancewith the invention, the DHEA is transformed to androgens only by naturalmechanisms in tissues that normally perform that transformationaccording to their local needs. The relative ratio of androgens andestrogens produced from the DHEA is also a substantially normal ratioinstead of being an abnormally elevated ratio of one type of sex steroidwhen that type alone is used.

In preferred embodiments, DHEA is administered for prevention ortreatment of osteoporosis at a dosage sufficient to maintainsubstantially normal serum concentration for young adults, approximately410 micrograms per liter, or in some embodiments 4-7 micrograms perliter, e.g. between 5 and 7 or between 6 and 7 micrograms per liter.These are also desirable levels for the other DHEA-responsiveindications discussed herein, except for contraception and prevention ofovarian and uterine cancer, where in some embodiments preferred dosagecould be increased up to 13 micrograms per liter as discussed inconnection with those particular indications in order to further inhibitLH secretion by the anterior pituitary gland.

In one preferred treatment for menopause, the invention seeks tosimultaneously maintain blood levels of estrogen and a sex steroidprecursor (e.g., DHEA or DHEA-S) within normal pre-menopausalparameters. The body converts DHEA-S to DHEA in most peripheral tissues.Without intending to be bound by theory, it is believed that maintenanceof appropriate precursor levels will better enable natural enzymes, suchas 17β-hydroxysteroid dehydrogenase, 3β-hydroxysteroidhydrogenase,aromatase and 5α-reductase to regulate production of androgens andestrogens and to maintain them in a manner more closely resembling theirrelative levels prevailing prior to menopause. Hence, the inventioncontemplates that not only estrogens but also androgens and precursorswill be kept in better balance. In fact, all target tissues possess theenzymatic machinery necessary to synthesize androgen and/or estrogensaccording to local control and need (Labrie, Mol. Cell. Endocrinol. 78,C113-C118, 1991). The estrogen and precursor (e.g., DHEA) whenadministered together in accordance with the invention may beadministered simultaneously or separately. Indeed, the second activeingredient (precursor) may be added to an existing estrogen therapy inorder to achieve the combination therapy of the invention.

It is necessary only that both the estrogen and precursor beadministered in a manner and at a dosage sufficient to allow blood serumconcentration of each to obtain desired levels. In accordance with thecombination therapy of the invention, concentration of the precursor ismaintained within desired parameters at the same time that estrogenconcentration is maintained within desired parameters. Where estradiolis used, serum estradiol concentration should typically be maintainedbetween 50 and 300 nanograms per liter, preferably between 100 and 200nanograms per liter and most preferably between 150 and 175 nanogramsper liter. Where another estrogen is used, serum concentration may bevaried in a known manner to account for the difference in estrogenicactivity relative to estradiol and in order to achieve normalpre-menopausal estrogen levels. A lesser concentration is needed, forexample, if Mestranol is used. Adequate serum estrogen levels can alsobe assessed by disappearance of the symptoms of menopause. Serumconcentration of the second compound of the combination therapy (e.g.,DHEA) is typically maintained between 4 and 10 micrograms per liter, orin some embodiments between 5 and 7 micrograms per liter, or between 6and 7 micrograms per liter.

The estrogen is preferably estradiol, but may be sodium estrone sulfateor another compound which acts as an estrogen receptor agonist. Whenadministered separately, commercially available estrogen supplements maybe used, e.g., PREMARIN available from Ayerst (St-Laurent, Quebec,Canada). One preferred precursor is DHEA, although DHEA-S and analogsdiscussed below are also especially effective for the reasons statedbelow. Where DHEA is used, for example, DHEA, pharmaceutical grade, iscommercially available from SIGMA (St-Louis, Mo., USA). For typicalpatients, the appropriate dosage of estrogen to achieve desired serumconcentrations is between 0.3 and 2.5 milligrams of PREMARIN per day per50 kg of body weight when administered orally. In certain embodiments ofthe invention, the estrogen may be 17β-estradiol administeredpercutaneously in a patch which is available from CIBA under the nameESTRADERM wherein the daily dose is between 0.05 and 0.2 milligrams perday per 50 kg of body weight. For typical patients, the appropriatedosage of the sex steroid precursor DHEA to achieve desired serumconcentration of the precursor is between 0.25 and 2.5 grams per day per50 kg of body weight when administered orally. Other sex steroidprecursors will be administered at a dosage that depends on their invivo conversion rate to DHEA. The precursor may also be administeredtransdermally, as described in more detail below, in a sufficient amountto achieve target serum concentration. That correlation is alsodiscussed in more detail below.

In another embodiment, menopause is treated with precursor as set forthabove, in combination with periodic administration of a progestin suchas medroxyprogesterone acetate (e.g. Provera) which is preferablyadministered intermittently, e.g. at a dosage of 2-10 mg per day for 12consecutive days, said 12-day periods being spaced 20 days to 5 monthsapart. A combination therapy using a precursor, an estrogen and aprogestin may also be used, preferably at the dosages discussed hereinfor each component.

The sex steroid precursor used in the invention may be administered withor without additional carrier or diluent by the oral route but requiresan additional carrier or diluent when administered by the preferredpercutaneous or transmucosal route. In a pharmaceutical composition fororal administration, DHEA or other precursor is preferably present in aconcentration between 5 and 98% by weight relative to total weight ofthe composition more preferably between 50 and 98 percent, especiallybetween 80 and 98 percent. If estrogen such as estradiol is present, itsconcentration is preferably from 0.04 to 0.4 percent by weight. A singleprecursor such as DHEA may be the only active ingredient, oralternatively, a plurality of precursors and/or their analogues may beused (e.g., a combination of DHEA and DHEA-S, or a combination of two ormore compounds converted in vivo to DHEA or DHEA-S, or a combination ofDHEA and one or more analogues thereof which are converted to DHEA invivo, etc. Where a combination is used, the total dosage of the sum ofall precursors should be equal to the dosage range recited above forDHEA used alone, with appropriate adjustment for the different molecularweights of DHEA analogues such as DHEA esters and their conversion rateto DHEA. Thus, if a DHEA ester is used instead of DHEA, dosage should beincreased by a multiple equivalent to the ratio of the molecular weightof the DHEA ester to the molecular weight of DHEA. The blood level ofDHEA is the final criteria of adequate dosage which takes into accountindividual variation in absorption and metabolism.

Preferably, the attending clinician will, especially at the beginning oftreatment, monitor an individual patient's overall response and serumlevels of both estrogen and DHEA (in comparison to the preferred serumconcentrations discussed above), and monitor the patient's overallresponse to treatment, adjusting dosages as necessary where a givenpatients' metabolism or reaction to treatment is atypical. One approachwould be to start treating with DHEA or its analogue(s) alone and to addthe estrogen only if estrogen blood levels remain too low. Many patientsmay be treated only with the precursors of the invention withoutadditional estrogen.

Treatment in accordance with the invention is suitable for indefinitecontinuation. Except for the higher dosage indications discussed above,it is expected that DHEA treatment will simply maintain DHEA levelswithin a range similar to that which occurs naturally in women beforemenopause (serum concentration between 4 and 10 micrograms per liter),or naturally in young adult men (serum concentration between 4 and 10micrograms per liter). Accordingly, undesirable side effects fromsustained DHEA treatment are expected to be either minimal ornonexistent. Avoiding side effects from sustained estrogen use may beachieved in ways already known to the art, for example, by intermittent(or in some embodiments continuous) administration of a progestin (e.g.,medroxy-progesterone acetate) at a daily oral dose of 2 to 10 mg.

In order to facilitate the combination therapy aspect of the invention,for any indication discussed herein, the invention contemplatespharmaceutical compositions which include both the estrogen and thesecond active compound (the precursor) in a single composition forsimultaneous administration. The composition may be suitable foradministration in any traditional manner including but not limited tooral administration, subcutaneous injection or intramuscular injection.In other embodiments, a kit is provided wherein the kit includes theestrogen and second compound (precursor(s)) in separate containers. Inaddition to other modes of administration, the second compound as wellas the estrogen may also be administered transdermally in accordancewith the invention as discussed in more detail below. Thus, the kit mayinclude appropriate materials for transdermal administration, e.g.,ointments, lotions, gels, creams, sustained release patches and thelike. The same strategy applies to the progestin. As noted above,estrogens are disfavored in combination therapies herein involving malepatients.

Applicants have discovered that administration of DHEA has utility inthe treatment and/or prevention of vaginal atrophy, osteoporosis, skinatrophy, uterine cancer, vaginal cancer, urinary incontinence,hypogonadism and diminished libido, and improves the overall balance ofcirculating sex steroids, including estrogens and androgens. It isbelieved that the prior art has not previously suggested that theseconditions respond to DHEA treatment. It is believed that DHEA, DHEA-Sor a compound converted in vivo to either may be useful in the treatmentof each of these disorders.

Prior art methods for systemic administration of DHEA have included oraland injection. Because DHEA treatments are often of prolonged andindefinite duration, repeated delivery by injection is veryinconvenient. Oral administration, however, has proven relativelyinefficient because orally administered DHEA goes first to the liverwhere a large percentage of it is prevented from entering the generalcirculation by local degradation.

We have recently observed that DHEA is very efficiently absorbedsystemically in both males and females following application to the skinor mucosa (e.g. buccal, vaginal or rectal mucosa). We have discoveredthat therapeutically efficient doses of DHEA may be administered by thepercutaneous or transmucosal route, thus avoiding first passage of thesteroid through the liver as results from oral administration, andfurther avoiding the discomfort and inconvenience of administering DHEAby injection.

Accordingly, the present invention provides delivery systems for theadministration of DHEA, DHEA-S and analogous compounds converted in vivoto either through the skin or mucosa. These systems are believed to bemore efficient than oral administration because the liver is bypassed.These systems are also significantly less painful and more convenientthan injections.

When DHEA, DHEA-S, or analogous compounds converted to DHEA or DHEA-S invivo are formulated for transdermal penetration, any of a number ofart-recognized transdermal penetration systems may be utilized. Forexample, DHEA may be prepared as part of an ointment, lotion, gel orcream for rubbing onto a patient's skin. Active ingredient is preferablypresent at from 7% to 20% by weight relative to the total weight of thepharmaceutical composition more preferably between 8 and 12%.Alternatively, the active ingredient may be placed into a transdermalpatch having structures known in the art, for example, structures suchas those set forth in E.P. Patent No.0279982.

When formulated as an ointment, lotion, gel or cream or the like, theactive compound is admixed with a suitable carrier which is compatiblewith human skin or mucosa and which enhances transdermal penetration ofthe compound through the skin or mucosa. Suitable carriers are known inthe art and include but are not limited to Klucel HF and Glaxal base.Some are commercially available, e.g., Glaxal base available from GlaxalCanada Limited Company. Other suitable vehicles can be found in Kollerand Buri, S.T.P. Pharma 3(2), 115-124, 1987. The carrier is preferablyone in which the active ingredient(s) is (are) soluble at ambienttemperature at the concentration of active ingredient that is used. Thecarrier should have sufficient viscosity to maintain the precursor on alocalized area of skin or mucosa to which the composition has beenapplied, without running or evaporating for a time period sufficient topermit substantial penetration of the precursor through the localizedarea of skin or mucosa and into the bloodstream where it will cause ameasurable and desired increase in serum DHEA concentration. The carrieris typically a mixture of several components, e.g. pharmaceuticallyacceptable solvents and a thickening agent. A mixture of organic andinorganic solvents can aid hydrophylic and lipophylic solubility, e.g.water and an alcohol such as ethanol.

Desirably, the carrier is one which, if formulated as 10% DHEA and 90%carrier (by weight) and applied twice daily in an amount providing 100mg of DHEA to the abdominal area, will elevate serum concentration ofDHEA in a typical patient by at least 0.35 micrograms per liter per 50kg of boby weight. As mentioned earlier, a Glaxal base, when used ascarrier under these conditions, provides an elevation of serum DHEAconcentration of about 0.7 μg per liter per 50 kg body weight.

The carrier may also include various additives commonly used inointments and lotions and well known in the cosmetic and medical arts.For example, fragrances, antioxidants, perfumes, gelling agents,thickening agents such as carboxymethylcellulose, surfactants,stabilizers, emollients, coloring agents and other similar agents may bepresent. When used to treat systemic diseases, the site of applicationon the skin should be changed in order to avoid excess localconcentration of steroids and possible overstimulation of the skin andsebaceous glands by androgenic metabolites of DHEA.

The precursor can also be administered, in some instances, by the oralroute, and may be formulated with conventional pharmaceuticalexcipients, e.g. spray dried lactose and magnesium stearate into tabletsor capsules for oral administration at concentrations providing easydosage in a range from 0.25 to 2.5 grams per day per 50 kg of bodyweight.

The active substance can be worked into tablets or dragee cores by beingmixed with solid, pulverulent carrier substances, such as sodiumcitrate, calcium carbonate or dicalcium phosphate, and binders such aspolyvinyl pyrrolidone, gelatin or cellulose derivatives, possibly byadding also lubricants such as magnesium stearate, sodium laurylsulfate, "Carbowax" or polyethylene glycol. Of course, taste-improvingsubstances can be added in the case of oral administration forms.

As further forms, one can use plug capsules, e.g. of hard gelatin, aswell as closed solf-gelatin capsules comprising a softner orplasticizer, e.g. glycerine. The plug capsules contain the activesubstance preferably in the form of granulate, e.g. in mixture withfillers, such as lactose, saccharose, mannitol, starches, such as potatostarch or amylopectin, cellulose derivatives or highly dispersed silicicacids. In solf-gelatin capsules, the active substance is preferablydissolved or suspended in suitable liquids, such as vegetable oils orliquid polyethylene glycols.

The concentration of active ingredient in the ointment, cream, gel orlotion is typically from about 7 to 20 percent preferably between 8 and12 percent and preferably 10 percent (by weight relative to the totalweight of the lotion, cream, gel or ointment). Within the preferredranges, higher concentrations allow a suitable dosage to be achievedwhile applying the lotion, ointment, gel or cream to a lesser surfacearea of the skin than would be possible at lower concentrations andallows more freedom in choosing the body parts to which the ointment orlotion will be applied. For example, it is well known in the art that acompound which is capable of transdermal penetration normally penetratesmore efficiently at some points in the body than in others. For example,penetration is very efficient on the forearm and considerably lessefficient on the palms.

The lotion, ointment, gel or cream should be thoroughly rubbed into theskin so that no excess is plainly visible, and the skin should not bewashed in that region until most of the transdermal penetration hasoccurred preferably at least 15 minutes and, more preferably, at least30 minutes.

A transdermal patch may be used to deliver precursor in accordance withknown techniques. It is typically applied for a much longer period,e.g., 1 to 4 days, but typically contacts active ingredient to a smallersurface area, allowing a slow and constant delivery of activeingredient.

A number of transdermal drug delivery systems that have been developed,and are in use, are suitable for delivering the active ingredient of thepresent invention. The rate of release is typically controlled by amatrix diffusion, or by passage of the active ingredient through acontrolling membrane.

Mechanical aspects of transdermal devices are well known in the art, andare explained, for example, in U.S. Pat. Nos. 5,162,037, 5,154,922,5,135,480, 4,666,441, 4,624,665, 3,742,951, 3,797,444, 4,568,343,5,064,654, 5,071,644, 5,071,657, the disclosures of which areincorporated herein by reference. Additional background is provided byEuropean Patent 0279982 and British Patent Application 2185187.

The device may be any of the general types known in the art includingadhesive matrix and reservoir-type transdermal delivery devices. Thedevice may include drug-containing matrixes incorporating fibers whichabsorb the active ingredient and/or carrier. In a reservoir-type device,the reservoir may be defined by a polymer membrane impermeable to thecarrier and to the active ingredient.

In a transdermal device, the device itself maintains active ingredientin contact with the desired localized skin surface. In such a device,the viscosity of the carrier for active ingredient is of less concernthan with a cream or gel. A solvent system for a transdermal device mayinclude, for example, oleic acid, linear alcohol lactate and dipropyleneglycol, or other solvent systems known in the art. The active ingredientmay be dissolved or suspended in the carrier.

For attachment to the skin, a transdermal patch may be mounted on asurgical adhesive tape having a hole punched in the middle. The adhesiveis preferably covered by a release liner to protect it prior to use.Typical material suitable for release includes polyethylene andpolyethylene-coated paper, and preferably silicone-coated for ease ofremoval. For applying the device, the release liner is simply peeledaway and the adhesive attached to the patient's skin. In U.S. Pat. No.5,135,480, the disclosure of which is incorporated by reference, Bannonet al. describe an alternative device having a non-adhesive means forsecuring the device to the skin.

Except for the higher dosage indications noted above (e.g.contraception), the target serum concentration of DHEA is comparableregardless of whether sex steroid precursor is being used as part of acombination therapy for treatment of menopause or is being used (byitself or in combination with estrogen and/or progestin) for thetreatment of skin deterioration, vaginal atrophy, urinary incontinence,uterine cancer, ovarian cancer, osteoporosis, hypogonadism or diminishedlibido in accordance with the invention or for the treatment of a widevariety of conditions related to decreased secretion of DHEA by theadrenals. It is pointed out that dosage of DHEA, DHEA-S or any analogdiscussed herein can all be correlated to a target serum concentrationof DHEA because all are converted in vivo, either directly orindirectly, into DHEA.

The percutaneous or transmucosal delivery system of the invention mayalso be used as a novel and improved delivery system for the preventionand/or treatment of osteoporosis or other diseases which respondfavorably to treatment with DHEA. The desired target serum levels forthese latter purposes is also the same as indicated above.

DHEA used for percutaneous or transmucosal application can be in theform of the free alcohol or of one or more of its derivatives, e.g.valerate, benzoate, acetate, enanthate and fatty ester derivatives. Thedelivery of DHEA or of its analogues through the skin is an acceptable,comfortable and noninvasive way of administering such compound. It alsoavoids gastrointestinal irritation and degradation of the compound andtoxicologic problems due to first passage through the liver beforereaching the general circulation.

One method for preventing or inhibiting growth of breast and endometrialcarcinoma cells is activation of the androgen receptor with an effectivecompound having an affinity for the receptor site such that it binds tothe androgen receptor at low concentrations while not significantlyactivating other classes of steroid receptors linked to potential sideeffects.

Since DHEA is a natural source of androgens (Labrie, Mol. Cell.Endocrinol. 78: C113-C118, 1991) and the secretion of this compoundmarkedly decreases during aging, its replacement should have minimalunwanted side effects.

Percutaneous or transmucosal delivery of DHEA in accordance with theinvention thus provides a novel method for prevention and therapy ofdiseases responsive to activation of the androgen receptor, e.g. boneloss, obesity, breast cancer, endometrial cancer, ovarian cancer,urinary incontinence, hypogonadism, loss of libido, loss of muscle mass,loss of energy, and other aging processes. The invention is also usefulfor many diseases wherein activation of the estrogen receptor will havebeneficial effects, especially osteoporosis and vaginal atrophy. Theinvention also represents an improved delivery method (e.g. transdermal)for diseases already in the art as being candidates for DHEA treatment.

EXAMPLES OF SOME PREFERRED DERIVATIVES

Derivatives of DHEA or DHEA-S that are expected to convert in vivo toDHEA or DHEA-S in accordance with the present invention may be made bythe following approaches:

Esterification of the 3β function into an ester which can be cleaved byesterase (the cleavage does not generate toxic substances) andtransformation of the 17-keto group into oxazolidine or thiazoliodineswhich are unstable in the body and regenerate a natural precursor.

Formation at position 3β of an α-acyloxyalkyl ether which can be cleavedby esterase into an unstable hemiacetal. The decomposition of thishemiacetal regenerates the natural precursor.

Without modification of the 3β function, transformation of the 17-ketogroup into oxazolidine or thiazoliodines which are unstable in the bodyand regenerate DHEA or DHEA-S.

The compounds disclosed below are expected to convert in vivo intodehydroepiandrosterone (DHEA) or dehydroepiandrosterone-sulfate DHEA-S.##STR7## wherein R³ is hydroxy or sulfate.

wherein R^(e) is selected from the group consisting of hydrogen, benzyl,aryl, straight- or branched-alkyl, straight- or branched-alkenyl andstraight- or branched-alkynyl.

wherein Z is oxygen or sulfur.

Some derivatives of DHEA being more lipophilic than DHEA itself can bestocked in skin fat and advantageously release DHEA slowly over time.

In some preferred compounds of the invention, the function at position 3is an ester of sulfuric acid (or salts thereof), formic acid, aceticacid, benzoic acid, butyric acid, decanoic acid, enanthic acid, furoicacid, heptanoic acid, isocaproic acid, undecanoic acid, undecylenicacid, palmitic acid, phenylpropionic acid, pivalic acid, propionic acid,valeric acid, carbonic acid (preferably ethylcarbonate orbenzylcarbonate).

In some preferred compounds of the invention, DHEA (or DHEA-S) ismodified by a 17-substituent of the following formula: ##STR8## whereinR"' is selected from the group consisting of hydrogen, benzyl, straight-or branched-alkyl and straight- or branched-alkenyl.

Certain preferred 3β-ester derivatives of DHEA are listed below:

    ______________________________________     ##STR9##    COMPOUNDS              X    ______________________________________    dehydroepiandrosterone-3β-formate                           HCO    dehydroepiandrosterone-3β-acetate                           CH.sub.3 CO    dehydroepiandrosterone-3β-propionate                           CH.sub.3 CH.sub.2 CO    dehydroepiandrosterone-3β-butyrate                           CH.sub.3 (CH.sub.2).sub.2 CO    dehydroepiandrosterone-3β-valerate                           CH.sub.3 (CH.sub.2).sub.3 CO    dehydroepiandrosterone-3β-pivalate                           (CH.sub.3).sub.3 CCO    dehydroepiandrosterone-3β-benzoate                           C.sub.6 H.sub.5 CO    dehydroepiandrosterone-3β-furoate                           C.sub.4 H.sub.3 OCO    dehydroepiandrosterone-3β-cypionate                           C.sub.5 H.sub.9 (CH.sub.2).sub.2 CO    dehydroepiandrosterone-3β-lactate                           CH.sub.3 CHOHCO    dehydroepiandrosterone-3β-decanoate                           CH.sub.3 (CH.sub.2).sub.8 CO    dehydroepiandrosterone-3β-undecanoate                           CH.sub.3 (CH.sub.2).sub.10 CO    dehydroepiandrosterone-3β-palmitate                           CH.sub.3 (CH.sub.2).sub.14 CO    dehydroepiandrosterone-3β-ethylcarbonate                           C.sub.2 H.sub.5 OCO    dehydroepiandrosterone-3β-benzylcarbonate                           C.sub.6 H.sub.5 CH.sub.2 OCO    dehydroepiandrosterone-3β-isocaproate                           (CH.sub.3).sub.2 (CH.sub.2).sub.3 CO    dehydroepiandrosterone-3β-undecylenate                           H.sub.2 CCH(CH.sub.2).sub.8 CO    dehydroepiandrosterone-3β-enanthate                           CH.sub.3 (CH.sub.2).sub.5 CO    dehydroepiandrosterone-3β-phenylpropionate                           C.sub.6 H.sub.5 (CH.sub.2).sub.2 CO    3β-hydroxymethoxy-5-androsten-17-one acetate                           CH.sub.3 CO.sub.2 CH.sub.2    3β-hydroxymethoxy-5-androsten-17-one                           CH.sub.3 (CH.sub.2).sub.8 CO.sub.2 CH.sub.2    decanoate    ______________________________________

Some other preferred DHEA derivatives are listed below:

    ______________________________________     ##STR10##    COMPOUNDS             R'"        Z    ______________________________________    3β-hydroxy-5-androstene-17-spiro(1',3'-                          C.sub.2 H.sub.5                                     S    thiazolidine-4'-ethyl carboxylate)    3β-hydroxy-5-androstene-17-spiro(1',3'-                          C.sub.6 H.sub.5 CH.sub.2                                     S    thiazolidine-4'-benzyl carboxylate)    3β-hydroxy-5-androstene-17-spiro(1',3'-                          C.sub.6 H.sub.13                                     S    thiazolidine-4'-hexyl carboxylate)    3β-hydroxy-5-androstene-17-spiro(1',3'-                          C.sub.2 H.sub.5                                     O    oxazolidine-4'-ethyl carboxylate)    3β-hydroxy-5-androstene-17-spiro(1',3'-                          C.sub.6 H.sub.5 CH.sub.2                                     O    oxazolidine-4'-benzyl carboxylate)    3β-hydroxy-5-androstene-17-spiro(1',3'-                          C.sub.6 H.sub.13                                     O    oxazolidine-4'-hexyl carboxylate)    ______________________________________

Corresponding 17-substituted analogs of DHEA-S may also be used.

EXAMPLES OF SYNTHESIS Example 1 3β-formyloxy-5-andiostene-17-one

Following the procedure described by Ringold (H. J. Ringold, et al., J.Am. Chem. Soc. 78, 816, 1956), dehydroepiandrosterone (2.88 g, 10 mmol)dissolved in 85% formic add (100 mL) is heated at 60° C. for 1 h. Aftercooling, the mixture is poured into iced water and after 16 h, crystalsare filtered and dried in vacuo.

Example 2 3-acetoxy-5-androstene-17-one

Dehydroepiandrosterone (2.88 g, 10 mmol) is dissolved in a mixture (100ml) of anhydride acetic and pyridine (1:1 v/v) and left at roomtemperature for 16 h. The mixture is then poured carefully into icedwater and after 16 h, crystals are filtered and dried in vacuo.

Example 3 Dehydroepiandrosterone-3β-undecanoate

A solution of undecanoyl chloride (10.2 g, 50 mmol) in CH₂ Cl₂ (50 ml)was added to a mixture of 5androsten-3β-ol-17-one (11.53 g, 40 mmol),Et₃ N (14 ml, 100 mmol) and dimethylaminopyridine (0.6 g, 5 mmol) in CH₂Cl₂ (150 ml) at 5° C. After addition, the mixture was stirred overnightat room temperature. The CH₂ Cl₂ layer was washed successively withwater, 2N HCl (twice), 5% K₂ CO₃ (twice), brine and dried. Removal ofthe solvent gave the crude product which was recrystallized with amixture of n-hexane:benzene to give the pure product (13.66 g; 75%),M.P. 84°-85° C.; ¹ H-NMR (CDCl₃); δ0.83-0.86 (m, 6H, C₁₈ -CH₃ and CH₃);1.03 (s, 3H, C₁₉ -CH₃); 4.58-4.61 (m, 1H, C₃ -H); 5.37 (d, 1H, vinyl,J=4.89 Hz). ¹³ C-NMR (CDCl₃) δ:220.90, 179.25, 139.99, 121.78, 73.38,51.69, 50.14, 47.49, 38.12, 36.94, 36.72, 35.81, 34.68, 31.87, 31.47,31.42, 30.76, 29.53, 29.44, 29.27, 29.23, 29.09, 27.73, 25.03, 22.66,21.86, 20.31, 19.33, 14.09, 13.53.

Example 4 3β-acyloxy-5-androstene-17-one

The above esters at position 3β of dehydroepiandrosterone are preparedas follows:

Dehydroepiandrosterone (10 mmol) is dissolved in pyridine (50 mL) andadded to a solution of acyl chloride (prepared from the correspondingacid and oxalyl chloride) in the same solvant (50 mL).Dimethylaminopyridine (10%) is then added and the mixture is left atroom temperature for 16 h. The mixture is then carefully poured intoiced water and extracted with ethyl acetate. The organic phase is washedwith diluted HCl, water, saturated sodium bicarbonate and water, driedand evaporated to dryness to give the ester.

Example 5 3β-benzyloxycarbonyloxy-5-androsten-17-one

To a stirred solution of dehydroepiandrosterone (2.88 g, 10 mmol) inmethylene chloride (100 mL) is added dropwise benzylchloroformate, overa period of 30 min following the known procedure (F. Reber and T.Reichstein, Helv. Chim. Acta, 28, 1164, 1945). After stirring for 3 h,the mixture is washed with water and evaporated to dryness. The residueis then dissolved in acetone and precipitated in iced water. After 16 h,crystals are filtered and dried in vacuo.

Example 6 3β-ethoxyoxycarb onyloxy-5-androsten-17-one

Same procedure as described in example 5 except that ethylchloroformateis used instead of benzylchloroformate.

Example 7 3β-hydroxy-5-androstene-17-spiro-2'-(1',3'-thiazolidine-4'-ethyl carboxylate)

Following the procedure described by Djerassi (C. Djerassi, N. Crossleyand M. A. Kielczewski, J. Org. Chem. 27, 1112, 1962),dehydroepiandrosterone (2.88 g, 10 mmol) is dissolved in anhydrousethanol, sodium acetate is added followed by L-cysteine ethyl esterhydrochloride (18g, 100 mmol) and the mixture is heated overnight underan argon atmosphere. The reaction mixture is then evaported undervacuum. Methylene chloride is added to precipitate excess of L-cysteineethyl ester hydrochloride. The solution is then filtered and thefiltrate is washed twice with water, dried on magnesium sulfate,filtered and evaporated under vacuum. The residue is triturated withethanol to give crystals.

Example 8 3β-hydroxy-5-androstene-17-spiro-2'-(1',3'-thiazolidine-4'-benzyl carboxylate)

Same procedure as described in example 7 except that L-cysteine benzylester hydrochloride is used instead of L-cysteine ethyl esterhydrochloride.

Example 9 3β-hydroxy-5-androstene-17-spiro-2'-(1',3'-thiazolidine-4'-alkyl carboxylate)

Same procedure as described in example 7 except that differentL-cysteine alkyl esters hydrochloride (e.g. L-cysteine hexyl esterhydrochloride) are used instead of L-cysteine ethyl ester hydrochloride.

Example 10 3β-hydroxy-5-androstene-17-spiro-2'-(1',3'-oxazolidine-4'-ethyl carboxylate)

The same procedure as described in the Example 7 is used except theoxazolidine derivative is prepared using serine ethyl esterhydrochloride instead of L-cysteine ethyl ester hydrochloride.

Example 11 3β-hydroxy-5-androstene-17-spiro-2'-(1',3'-oxazolidine-4'-benzyl carboxylate)

Same procedure as described in example 10 except that serine benzylester hydrochloride is used instead of serine ethyl ester hydrochloride.

Example 12 3β-hydroxy-5-androstene-17-spiro-2'-(1',3'-oxazolidine-4'-alkyl carboxylate)

Same procedure as described in example 10 except that different serinealkyl esters hydrochloride (e.g. serine hexyl ester hydrochloride) areused instead of serine ethyl ester hydrochloride.

Example 13 3β-hydroxymethoxy-5androsten-17-one acetate

To a solution of dehydroepiandrosterone (2.88 g, 10 mmol) in THF (100mL) is added sodium hydride (11 mmol, 60% in oil) at room temperatureunder an argon atmosphere. When all the sodium hydride has reacted,chloromethyl acetate (prepared from acetyl chloride and formaldehyde (orderivative) using ZnCl₂ as catalyst) is added and the mixture is heatedfor a few hours. After cooling, the mixture is poured into water andextracted with ethyl acetate. The organic phase is then washed withwater, dried, filtered and evaporated to dryness to give the desiredcompound.

EXAMPLES OF PHARMACEUTICAL COMPOSITIONS

In one aspect, the present invention involves applying DHEA (or itsanalogues) formulation to the skin or other epithelial tissue for a timeperiod sufficient to permit sufficient penetration of the compound forsystemic or topical action, as desired. The composition may be appliedas a gel, a cream, an ointment, a lotion or the like or may involve useof a delivery system as described in U.S. Pat. Nos 3,742,951, 3,797,494or 4,568,343. Devices as described in U.S. Pat. Nos 5,064,654, 5,071,644or 5,071,657 can also be used to facilitate steroid absorption.

All the pharmaceutical compositions of the present invention may containappropriate preservatives known in the art.

The following non-limiting examples describe the preparation of atypical cream, lotion, gel and ointment, respectively. In addition tothese vehicles, one skilled in the art may choose other vehicles inorder to adapt to specific dermatologic needs.

Example 14

A typical lotion contains (W/W) 10% DHEA, 15% propylene glycol and 70%ethanol and water 5%.

Example 15

A typical gel contains (W/W) 10% DHEA, 5% propylene glycol, 0.2%Carbomer 940 (available as Carbopol 940^(R) from B. F. Goodrich), 40%water, 0.2% triethanolamine, 2% PPG-12-Buteh-16 (available as Ucon^(R)fluid 50 from Union Carbide), 1% hydroxypropyl and 41.6% ethanol (95%ethanol-5% water).

Example 16

A typical ointment contains (W/W) 10% DHEA, 13% propylene glycol, 74%petrolatum, 2.9% glycerylmonostearate and 0.1% polylparaben.

Example 17

A typical cream contains (W/W) 10% DHEA, 0.2% propylparaben, 5% lanolinoil, 7.5% sesame oil, 5% cetyl alcohol, 2% glyceryl monostearate, 1%triethanolamine, 5% propylene glycol, 0.1% Carbomer 940^(R) and 64.2%water.

In each of the foregoing Examples 14-17, a progestin and/or an estrogenmay be added. For example 0.005 to 0.02% 17β-estradiol and/or 0.2 to2.0% medroxyprogesterone acetate may be added with correspondingreductions in water or ethanol or petrolatum. DHEA permeability can beenhanced by various techniques in order to reduce the dose used. Methodsand compositions for enhancing permeability of an active compound can befound, for example, in U.S. Pat. Nos. 5,051,260, 4,006,218, 3,551,554,3,472,931, 4,568,343, 3,989,816 and 4,405,616.

Although the present invention has been described in relation toparticular embodiments thereof, many other variations and modificationsand other uses will become apparent to those skilled in the art. It ispreferred, therefore, that the present invention be limited not by thespecific disclosure herein, but only by the appended claims.

What is claimed is:
 1. A method for inhibiting the development andproliferation, or treatment, of uterine cancer compromisingadministering to a female patient in need thereof a therapeuticallyeffective amount of a sex steroid precursor selected from the groupconsisting of DHEA, DHEA-S, and compounds converted in vivo to either.2. The method of claim 1, wherein said precursor is administered at adosage sufficient to maintain serum DHEA concentration of said femalebetween 7 and 13 micrograms per liter.
 3. The method of claim 1, whereinsaid precursor is DHEA.
 4. The method of claim 1, further comprisingadministering a therapeutically effective amount of a progestin.
 5. Amethod for inhibiting the development and proliferation, or treatment,of uterine cancer compromising administering to a female patient in needthereof a therapeutically effective amount of a pharmaceuticalcomposition comprising a pharmaceutically acceptable diluent or carrierand a sex steroid precursor selected from the group consisting of DHEA,DHEA-S, and compounds converted in vivo to either.
 6. The method ofclaim 5, wherein said composition is administered at a dosage sufficientto maintain serum DHEA concentration of said patient between 7 and 13micrograms per liter.
 7. The method of claim 5, wherein said precursoris DHEA.
 8. The method of claim 5, wherein said pharmaceuticalcomposition further comprises a therapeutically effective amount of aprogestin.